There are few reports comparing flexible and rigid bronchoscopy in adult foreign body (FB) aspiration. The aim of this retrospective study was to review the clinical characteristics, outcomes and factors associated with success in adult patients who underwent flexible or rigid bronchoscopy for airway FB removal.We retrospectively reviewed the records of 103 patients who underwent bronchoscopy to remove airway FB at Samsung Medical Center, South Korea from January 1999 to March 2017.The median patient age was 64 years, and 70% were males. Among the 54 patients who underwent flexible bronchoscopy as first-line treatment, 43 (80%) patients had their FB successfully removed. Previous attempts at other hospitals was significantly associated with failed flexible bronchoscopy [9/11 (82%) vs. 3/43 (7%), P<0.001]. Delayed diagnosis (median 29 vs. 5 days, P=0.074) and peripherally located airway FB [9/12 (75%) vs. 23/48 (48%), P=0.115] were factors that trended towards flexible bronchoscopy failure. All of the 59 patients who underwent rigid bronchoscopy had their FB successfully removed. Rigid bronchoscopy was preferred to flexible bronchoscopy in patients with no comorbidities [38/59 (64%) vs. 18/44 (41%), P=0.018], previous attempts at other hospitals [34/59 (58%) vs. 4/44 (9%), P<0.001], delayed diagnosis (median 162 vs. 5 days, P<0.001), and hard FBs [48/62 (77%) vs. 21/49 (43%), P<0.001].Our data suggest that previous failed attempts and delayed diagnosis are associated with flexible bronchoscopy failure. However, rigid bronchoscopy could be effective in removing an airway FB even in these cases. Further studies to identify factors to facilitate optimal patient selection will minimize failure rates and optimize resource utilization.
Purpose: This study evaluated the anti-inflammatory properties of a cannabidiol (CBD) extract obtained by supercritical fluid extraction (SFE) from <i>Cannabis sativa</i> L. and a cream containing the extract. Methods: The CBD extract was quantitatively analyzed using high-performance liquid chromatography. We used a lipopolysaccharide (LPS)-induced RAW 264.7 cell model of inflammation to determine the anti-inflammatory effect of the CBD extract by measuring nitric oxide (NO) production. We evaluated the anti-inflammatory properties of a cream containing the CBD extract by measuring interleukin-1 alpha (IL-1α) levels induced by sodium dodecyl sulfate (SDS) in KeraSkin<sup>TM</sup>, a human skin model. The cytotoxicity of the CBD and CBD-containing cream was assessed by MTT assay in each model. Results: The average purity of the CBD extracted and refined by SFE was 99.40%. The CBD extract and CBD cream showed concentration-dependent inhibition of inflammation. At 4 μg/mL, NO production in the RAW 264.7 cell model was significantly decreased by 64.98% compared with the negative control. IL-1α production induced by SDS in the KeraSkin<sup>TM</sup> model decreased by 54.17% in the group treated with cream containing 0.4% CBD compared with the negative control and 22.09% compared with the positive control groups. Conclusion: The medicinal use of CBD is attracting interest in Korea. Our study confirmed its exceptional anti-inflammatory properties and effectiveness in a cream product. Should additional research confirm its safety and efficacy, CBD is expected to replace existing anti-inflammatory ingredients.
Juvenile xanthogranuloma (JXG) is a proliferative histiocytic disorder experienced during childhood and adolescents, and most commonly presents in the first two decades of life (1). JXG is not a true neoplasm, but rather a reactive proliferation of histiocytes, and belongs to the category of non-Langerhans dendritic cell disorders. However, the etiology and pathogenesis of JXG are still unknown. Most cases present as a solitary cutaneous lesion followed by a soft tissue mass in the head and neck region. Extracutaneous JXG, especially when involving only the spinal column, is extremely rare in adults. Through a review of the literature, we identified only three previous cases, which were in a 38-year-old male, 29-year-old male, and 41-year-old female (2-4). We describe a 67-year-old female who presented with an intradural-extramedullary (IDEM) tumor of the spinal cord. To our knowledge, this case report represents the oldest patient with a new presentation of spinal JXG. We report magnetic resonance imaging (MRI) findings of JXG of the spinal cord, which were then pathologically confirmed.
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